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Real World Evidence (RWE) 101 – ‘Interventional’ Clinical Trial vs Non-Interventional Study

RWE 101 – ‘Interventional’ Clinical Trial vs Non-Interventional Study

Interventional Clinical Trial: In this type of study, researchers actively intervene by assigning participants to different groups, administering specific treatments, or manipulating variables. The primary objective is to assess the safety and efficacy of new interventions e.g., drug or medical device.
 
Key characteristics of interventional clinical trials include:
 
Randomization: Participants are randomly assigned to different groups, such as the experimental group receiving the intervention and the control group receiving a placebo or standard treatment.

Intervention: Researchers actively administer a specific treatment or intervention to the participants.

Control Group: There is often a control group that receives a placebo or standard treatment for comparison.

Primary Outcomes: Trials are designed to measure predefined primary outcomes, such as improvements in health outcomes, survival rates, or reduction in symptoms.

Regulatory Oversight: Interventional trials require regulatory approval and are usually subject to stricter (risk-proportionate) regulations than non-interventional studies.
 
Non-interventional Study: These studies focus on collecting data without any active healthcare or treatment intervention imposed by the researchers. Researchers observe and collect information from participants in their natural settings (real world settings) or through retrospective analysis of existing data (secondary use of existing data).
 
Key characteristics of non-interventional studies include:
 
Observation: Researchers observe participants and collect data without actively intervening in the healthcare management of the participant or administering any specific treatment (treatment intervention).

Natural Setting: Data is collected in the real-world clinical practice or from existing databases, medical records, surveys, or interviews.

Descriptive Analysis: Non-interventional studies often aim to describe and analyze associations, relationships, patterns, or risk factors in the population under study.

Retrospective or Prospective: Data can be collected retrospectively by analyzing past records or prospectively by following participants over time.

No Randomization: Participants are not randomly assigned to groups, and treatment decisions are made by healthcare providers according to routine clinical practice.

Regulatory Oversight: Every country regulates non-interventional studies differently. The regulatory burden can therefore be much higher than expected.
 
Both ‘interventional’ clinical trials and non-interventional studies play important roles in advancing medical knowledge. Interventional trials provide more rigorous evidence for evaluating new interventions, while non-interventional studies offer insights into real-world effectiveness, population health, and long-term outcomes.

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Real World Evidence (RWE) 101 – ‘Interventional’ Clinical Trial vs Non-Interventional Study2023-08-07T12:55:06+00:00

Real World Evidence (RWE) 101 – Are the terms ‘clinical study’ and ‘clinical trial’ synonymous in the context of non-interventional studies?

RWE 101 – Are the terms ‘clinical study’ and ‘clinical trial’ synonymous in the context of non-interventional studies?

No, “clinical study” and “clinical trial” are not necessarily synonymous in the context of non-interventional studies in the EU.

In general, a clinical study refers to any investigation involving human participants that is intended to discover or verify the clinical, pharmacological or other pharmacodynamic effects of one or more medicinal products, or to identify any adverse reactions to one or more medicinal products. This can include both (interventional) clinical trials and non-interventional studies.

A clinical trial, on the other hand, specifically refers to a type of interventional clinical study where one or more medicinal products are tested in human participants with the aim of evaluating their safety and/or efficacy i.e., there is a treatment intervention involving a medicinal product.

Non-interventional studies (NIS) are observational studies that do not involve any treatment interventions or protocol-dictated administration of a medicinal product. They are designed to observe patients in their natural clinical setting and collect data on the outcomes of a specific drug or treatment intervention.

So, while a clinical trial is a type of clinical study, not all clinical studies are clinical trials.
 
Revision 2 of ICH GCP caused confusion to those of us who work with non-interventional studies. The glossary claimed that a ‘clinical trial’ was synonymous with a ‘clinical study’ (Section 1.12 of ICH GCP(R2)). This works if you conduct clinical trials (they are a type of clinical study), but not if you conduct non-interventional studies, which are a type of ‘clinical study other than a clinical trial’ (Article 2.2(4) of Regulation EU/536/2014).
 
The (draft) Revision 3 of ICH GCP includes a new definition of ‘clinical trial’ provided in the Glossary, which removes any confusion regarding clinical trial vs clinical study.

Clinical Trial = Any interventional investigation in human participants intended to discover or verify the clinical, pharmacological and/or other pharmacodynamic effects of an investigational product(s); and/or to identify any adverse reactions to an investigational product(s); and/or to study absorption, distribution, metabolism and excretion of an investigational product(s) with the object of ascertaining its safety and/or efficacy.

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Real World Evidence (RWE) 101 – Are the terms ‘clinical study’ and ‘clinical trial’ synonymous in the context of non-interventional studies?2023-08-07T12:48:43+00:00

Real World Evidence (RWE) 101 – The Importance of Regulatory Definitions

RWE 101 – The Importance of Regulatory Definitions

“Words are powerful”

Regulatory definitions are important in the context of real-world evidence (RWE) studies and real-world research for several reasons:

[1] Consistency: Regulatory definitions provide a consistent framework for generating and evaluating RWE across different stakeholders, including regulatory agencies, industry, and academia. By providing a clear and consistent definition of RWE, stakeholders can ensure that they are using the same language and criteria for evaluating the quality and relevance of RWE.

[2] Standards: Regulatory definitions help establish standards for the use of RWE in regulatory decision-making. For example, regulatory definitions may specify the types of RWE that are acceptable for use in regulatory submissions, the study designs that are appropriate for generating RWE, and the quality standards that must be met to ensure the reliability and validity of RWE.

[3] Decision-making: Regulatory definitions facilitate regulatory decision-making by providing a clear framework for evaluating the quality and relevance of RWE. By establishing clear criteria for evaluating RWE, regulatory agencies can make more informed decisions about the safety, efficacy, and quality of healthcare products.

[4] Transparency: Regulatory definitions promote transparency by providing a clear and consistent framework for generating and evaluating RWE. This can help ensure that stakeholders are aware of the criteria used to evaluate RWE and can provide input into the development of regulatory definitions.

[5] Compliance: Regulatory definitions help ensure compliance with regulatory requirements. By providing a clear definition of RWE and the standards for generating and evaluating it, stakeholders can ensure that their studies and research meet regulatory requirements.

In summary, regulatory definitions are important in the context of RWE studies and real-world research because they provide consistency, establish standards, facilitate decision-making, promote transparency, and ensure compliance with regulatory requirements. By providing a clear and consistent framework for generating and evaluating RWE, regulatory definitions can help stakeholders make more informed decisions about the safety, efficacy, and quality of healthcare products.

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Real World Evidence (RWE) 101 – The Importance of Regulatory Definitions2023-08-07T12:42:16+00:00

Real World Evidence (RWE) 101 – Regulatory Compliance

RWE 101 – Regulatory Compliance

Regulatory compliance in the context of real-world evidence (RWE) refers to ensuring that the generation and use of RWE for regulatory purposes are in accordance with applicable laws, regulations, and guidelines. RWE is increasingly being used to support regulatory decision-making in healthcare, particularly in the evaluation of the safety and effectiveness of medical products.

To ensure regulatory compliance when using RWE, organizations must follow the regulatory requirements and guidelines set forth by regulatory agencies such as the FDA in the United States, the EMA in the European Union, and other national regulatory bodies. These requirements and guidelines include criteria for the selection and use of RWE sources, study design, data quality, data privacy, and transparency.

For example, the FDA has published guidance on the use of RWE in regulatory decision-making, which outlines the criteria for using RWE to support the approval of new indications for existing drugs and to satisfy post-marketing study requirements. The guidance stresses the importance of ensuring that RWE studies are designed to address the regulatory question at hand, have appropriate data quality, and include appropriate statistical analyses.

In addition, regulatory compliance in the context of RWE also requires organizations to adhere to ethical standards for the protection of human subjects and patient privacy. Organizations must ensure that RWE studies are conducted in accordance with ethical principles, and that the data collected and analyzed are anonymized, pseudoanonymised, or de-identified to protect patient privacy.

Overall, regulatory compliance in the context of RWE requires organizations to carefully follow regulatory requirements and guidelines to ensure that the RWE generated and used for regulatory purposes is of high quality, meets ethical standards, and meets the regulatory agency’s criteria for acceptability.

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Real World Evidence (RWE) 101 – Regulatory Compliance2023-08-07T12:34:31+00:00

Real World Evidence (RWE) 101 – Regulatory Intelligence

RWE 101 – Regulatory Intelligence

In the context of real-world evidence (RWE) and real-world research (RWR), regulatory intelligence refers to the process of gathering, analyzing, and interpreting regulatory information from various sources to support compliance with regulatory requirements and inform decision-making.

Regulatory intelligence can help stakeholders in the healthcare industry, such as pharmaceutical companies, medical device manufacturers, and healthcare providers, to understand and navigate the complex and ever-changing regulatory landscape. It involves tracking and analyzing regulatory developments, including new and updated regulations, guidance documents, and policies, as well as monitoring regulatory enforcement actions, such as warning letters and product recalls.

By staying up-to-date with regulatory requirements and trends, stakeholders can better assess the potential regulatory implications of RWE and RWR studies, ensure compliance with relevant regulations, and make informed decisions about product development, clinical trials, and post-market surveillance.

In short…regulatory intelligence is a critical component of RWE and RWR that helps ensure that stakeholders are aware of and able to comply with regulatory requirements in their respective fields.

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Real World Evidence (RWE) 101 – Regulatory Intelligence2023-08-07T12:28:28+00:00

Real World Evidence (RWE) 101 – Regulatory Science

RWE 101 – Regulatory Science

Regulatory science is a field of study that involves the application of scientific methods, principles, and data to the development and evaluation of regulatory policies, standards, and practices. In the context of real-world evidence (RWE), regulatory science plays an important role in evaluating the safety, efficacy (effectiveness), and quality of healthcare products and in developing evidence-based regulatory decisions.

Regulatory science in the context of RWE focuses on the use of RWE to support regulatory decision-making. This involves evaluating the quality and relevance of RWE for specific regulatory purposes, such as assessing the effectiveness of a new drug or medical device in a real-world setting. Regulatory science also involves developing and refining methodologies for generating and analyzing RWE, such as observational studies or real-world randomized controlled trials (e.g., pragmatic clinical trials, cluster randomized trials etc).

The use of RWE in regulatory decision-making is becoming increasingly important as stakeholders seek to better understand the real-world performance of healthcare products and as regulators seek to make more informed decisions based on the best available evidence. Regulatory science provides a framework for evaluating the quality and relevance of RWE and for ensuring that it is used appropriately in regulatory decision-making.

In summary, regulatory science in the context of RWE is a field of study that focuses on the use of scientific methods and data to support regulatory decision-making. It involves evaluating the quality and relevance of RWE, developing and refining methodologies for generating and analyzing RWE, and ensuring that RWE is used appropriately in regulatory decision-making.

 

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Real World Evidence (RWE) 101 – Regulatory Science2023-08-07T12:19:12+00:00

Real World Evidence (RWE) 101 – NICE Real World Evidence Framework

RWE 101 – NICE Real World Evidence Framework

The UK’s National Institute for Health and Care Excellence (NICE) has developed a Real World Evidence (RWE) Framework to help evaluate the effectiveness and value of healthcare interventions using real-world data.

The key points of the NICE RWE framework include:

[1] Definition of RWE: Real-world data (RWD) are data collected outside of clinical trials, from sources such as electronic health records, claims databases, and patient registries. RWE is the use of RWD to generate evidence on the effectiveness, safety, and value of healthcare interventions.

[2] Scope of RWE: The NICE RWE Framework focuses on using RWE to inform decisions about the effectiveness and value of healthcare interventions in the UK.

[3] Quality and reliability of RWE: NICE emphasizes the need for high-quality and reliable RWE, which should meet certain standards in terms of data completeness, accuracy, consistency, and validity.

[4] Applicability of RWE: NICE recommends that RWE should be used in combination with other types of evidence, such as randomized controlled trials, to ensure that it is applicable to the population of interest and that the findings are robust.

[5] Analysis and interpretation of RWE: The NICE RWE Framework provides guidance on how to analyze and interpret RWE, including methods for adjusting for confounding factors and biases.

[6] Transparency and reproducibility: NICE emphasizes the importance of transparency and reproducibility in RWE studies, which should be clearly documented and reported to enable independent validation and replication.

[6] Ethical considerations: NICE highlights the need for ethical considerations in RWE studies, including data privacy and security, informed consent, and protection of vulnerable populations.

Overall, the NICE RWE Framework provides a structured approach to using real-world data to inform healthcare decision-making, while ensuring that the data is of high quality and the studies are conducted ethically and transparently.

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Real World Evidence (RWE) 101 – NICE Real World Evidence Framework2023-08-07T12:13:03+00:00

Real World Evidence (RWE) 101 – The Role of RWE in Health Technology Assessments (HTAs)

RWE 101 – The Role of RWE in Health Technology Assessments (HTAs)

Real-world evidence (RWE) is becoming increasingly important in the context of health technology assessment (HTA), which is the process of evaluating the clinical and economic impact of healthcare interventions. HTA is used to inform decisions about which treatments, technologies, and interventions should be funded and made available to patients.

RWE can play an important role in HTA by providing additional data on the safety, effectiveness, and cost-effectiveness of healthcare interventions, beyond what is typically available from clinical trials. RWE can be generated from a variety of sources, including electronic health records, administrative claims data, patient registries, and other real-world data sources.

RWE can be used to supplement or replace data from clinical trials, particularly in situations where the clinical trial data is limited or may not fully reflect real-world conditions. For example, RWE can provide information on how interventions work in different patient populations, including those with comorbidities or other conditions that may not have been included in clinical trials.

In addition, RWE can provide valuable information on the long-term effectiveness and safety of interventions, as well as their impact on patient quality of life and other patient-centered outcomes. This information can be particularly important in assessing the value of interventions over the long term and in different patient populations.

Overall, RWE can play an important role in improving the quality and accuracy of HTA, by providing additional data and insights that can help to inform decisions about which healthcare interventions should be funded and made available to patients.

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Real World Evidence (RWE) 101 – The Role of RWE in Health Technology Assessments (HTAs)2023-08-07T12:06:50+00:00

Real World Evidence (RWE) 101 – Verifying the Source of Data (Not to be Confused with Source Data Verification…Yup! Confusing!)

RWE 101 – Verifying the Source of Data (Not to be Confused with Source Data Verification…Yup! Confusing!)

Verifying the source of data is critical in the context of real world evidence (RWE) because the quality and reliability of the data are essential for generating accurate and trustworthy evidence. RWE is derived from real-world data (RWD), which is often collected from a variety of sources, including electronic health records (EHRs), claims databases, patient registries, and wearable devices.

There are several reasons why it is important to verify the source of RWD used to generate RWE:

Data quality: The quality of RWD can vary depending on the source, and it is essential to ensure that the data used to generate RWE are of high quality. Verification of the data source can help ensure that the data have been collected and managed in accordance with accepted standards and best practices.

Data completeness: Ensuring that the RWD used to generate RWE are complete and accurate is critical to the validity and reliability of the evidence. Verification of the data source can help ensure that all relevant data have been captured and that there are no gaps or inconsistencies in the data.

Data relevance: RWE is generated from RWD that may come from diverse sources, and it is important to verify that the data are relevant to the research question or hypothesis being investigated. Verification of the data source can help ensure that the data used to generate RWE are appropriate for the research question being addressed.

Data bias: RWD can be subject to various types of bias, including selection bias, measurement bias, and confounding bias. Verification of the data source can help identify potential sources of bias and enable appropriate adjustments to be made to the analysis to account for any bias.

In summary, verifying the source of data used to generate RWE is critical to ensure that the evidence generated is accurate, reliable, and trustworthy. It can help ensure that the data are of high quality, complete, relevant, and free from bias, which are all essential for generating high-quality evidence that can inform clinical decision-making and healthcare policy.

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Real World Evidence (RWE) 101 – Verifying the Source of Data (Not to be Confused with Source Data Verification…Yup! Confusing!)2023-08-07T11:35:44+00:00
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